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A Randomized Trial of Personalized Cognitive-Behavior Therapy for Alcohol Use Disorder in a Public Health Clinic942.17 kB
Published VersionCC BY V4.0, Open Access
Journal article
A Randomized Trial of Personalized Cognitive-Behavior Therapy for Alcohol Use Disorder in a Public Health Clinic
Frontiers in Psychiatry, Vol.9, pp.1-12
2018
PMCID: PMC6048280
PMID: 30042699
Abstract
Background: Tailored psychological interventions based on individual risk factors are likely to improve treatment for Alcohol Use Disorders (AUDs). Key risk factors for poor treatment outcome include alcohol craving, positive expectations of alcohol consumption, and impulsivity.
Design: Pragmatic randomized Cognitive-Behavioral Treatment (CBT) trial.
Setting: Public hospital alcohol and drug clinic.
Participants: Three-hundred seventy-nine patients (65% male; Ageyears M = 44.32, SD = 10.75) seeking treatment for AUD.
Procedure: Patients were randomly allocated into treatment as usual (TAU) or targeted treatment. Patients in targeted treatment were allocated one of three treatment modules focusing on craving, positive expectancy, or impulsivity based on assessment results. Treatment included eight, 1 h sessions of CBT over 12 weeks delivered by clinical psychologists.
Hypotheses: Targeted treatment was expected to have fewer drinking days and consume less alcohol during the treatment period than TAU. Improvement in targeted mechanisms was predicted to be greatest for patients within matched conditions.
Results: Patients attended an average of 4.4 sessions with 93 (25%) completing the whole 12-week treatment episode. The mean proportion of drinking days between sessions was 5% with an average consumption of 64 grams of ethanol. No significant effect of targeted treatment was identified on drinking days or consumption. The craving (b = −18.97, 95% CI = −31.44, −6.51) and impulsivity (b = −26.65, 95% CI = −42.09, −11.22) modules demonstrated significant reductions in their targeted constructs over treatment, above TAU. Only reduction in craving was associated with reduced drinking days [exp(b) = 0.958, p = 0.003] and alcohol consumption [exp(b) = 0.962, p = 0.02]. Significant indirect effects for the targeted craving module through craving reduction were identified for reduction in drinking days (β = −0.72, 95% CI = −1.50, −0.158) and alcohol consumption (β = −0.78, 95% CI = −1.72, −0.11).
Conclusions: In the context of a public health service, the effectiveness of individualized treatment targeting risk mechanisms identified during pre-treatment assessment was not confirmed. Some evidence was found for improved treatment response to the implementation of a manualized craving module when pre-treatment craving was high
Details
- Title
- A Randomized Trial of Personalized Cognitive-Behavior Therapy for Alcohol Use Disorder in a Public Health Clinic
- Authors
- Jason M Coates (Author) - The University of QueenslandMatthew J Gullo (Author) - The University of QueenslandGerald F. X Feeney (Author) - The University of QueenslandRoss Young (Author) - Queensland University of TechnologyJason P Connor (Author) - The University of Queensland
- Publication details
- Frontiers in Psychiatry, Vol.9, pp.1-12
- Publisher
- Frontiers Research Foundation
- Date published
- 2018
- DOI
- 10.3389/fpsyt.2018.00297
- ISSN
- 1664-0640
- PMID
- 30042699; PMC6048280
- Copyright note
- Copyright © 2018 Coates, Gullo, Feeney, Young and Connor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
- Organisation Unit
- University of the Sunshine Coast, Queensland; Office of the Deputy Vice-Chancellor (Research and Innovation)
- Language
- English
- Record Identifier
- 99551606502621
- Output Type
- Journal article
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